Sex and the menopause

The menopause is the time when a woman's periods stop. In the UK, this usually happens between the ages of 47 and 53. How could the menopause affect my sex life adversely?

By
Dr David Delvin

05/02/2015

Getty ImagesPeter Cade

What is the menopause?

The menopause is the time when a woman's periods stop. In the UK, this usually happens between the ages of 47 and 53. People often refer to it as 'the change.'

What usually happens is that in the years leading up to the menopause, the level of oestrogen (an important female sex hormone that is produced by the ovaries) starts to decline – and then falls sharply.

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This fall can sometimes have these effects:

the vagina and vulva (the vaginal opening) may become a little dryer

as a result, the woman may experience discomfort or even pain during sex

she may become slightly more vulnerable to urinary infections

her breasts may lose some of their bulk

her skin may become a little less elastic.

If you are unlucky, the drop in your oestrogen levels may possibly lead to two distressing symptoms:

hot flushes

sweating attacks at night.

However, a lot of women do actually sail through the menopause with little or nothing in the way of unpleasant symptoms.

Can I have sex during and after the menopause?

Yes! Even today one sometimes reads articles in the newspapers that suggest that most women lose their sexual desire at the menopause – and that many of them have little sexual activity thereafter. This is nonsense.

An important note about family planning

A woman's fertility starts to fall after about the age of 35, but many women have been surprised when they have become pregnant unexpectedly in their late 40s or even early 50s.

So, late pregnancy can and does happen, and therefore it is important to think about contraception – even after the menopause.

The recommended advice is:

women who reach the menopause at 50 or over should use contraception for 12 months after their last period

women who are under 50 when they have their menopause should continue to use contraception for two years after their last period. Please remember that HRT is not a contraceptive.

The truth is that there's no reason why you can't continue to enjoy a happy and satisfying sex life during and after the menopause, if you want to.

My colleagues and I have found that many women enjoy wonderful sex lives after they've passed the menopause – and continue to do so for a very long time.

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We have even uncovered some evidence that:

women who are interested in sex are more likely to be orgasmic after the 'change' than younger females

they are also more likely to be multi-orgasmic!

There are three main reasons for this.

After the 'change' women are glad to be able to quit worrying about contraception.

By the time they reach 50 or so, a lot of women have gained a great deal of love-making experience and skill.

Very often, they now have partners (male or female) who actually know what they're doing in bed! (Though of course, a few postmenopausal women – notably certain film stars – decide to take 'toy boys' as lovers.)

Recently, one of us (Christine Webber) conducted a survey among women aged 45 to 65.

The findings showed that in that age group 26 per cent of women were definitely up for sex, while 29 per cent 'quite liked it'.

Only 6 per cent were not at all keen, and 16 per cent said that they'd be more interested if they had a new partner!

How could the menopause affect my sex life adversely?

It's fair to say that many women have a great time in bed after they pass the menopause. However, others don't.

These are some problems that can occur.

Lack of oestrogen can cause the above-mentioned vaginal dryness and soreness. This can make sex uncomfortable or even painful. Fortunately, this problem responds very well to vaginal hormone cream.

Night sweats and hot flushes. These can be counterproductive to relaxation and romance. At night, such symptoms produce an intolerable feeling of heat, often accompanied by profuse sweating, and even a feeling of claustrophobia. If the sufferer has to throw off the bed sheets and open the windows when night sweats are at their worst, she's not going to feel like absorbing even more body heat from her sexual partner!

Irregular periods can make the timing of spontaneous love-making difficult. (However, the menopause shouldn't really cause badly irregular periods; if yours are 'all over the place' consult your doctor.)

Some women are conscious of dry skin, changes in the shape of their breasts and of a gradual redistribution of weight away from their breasts towards their waistline.

Loss of libido can sometimes occur; but in fact only a minority of women complain that after the menopause they lose their desire for sex. If it happens, then partners may feel rejected, and so relationship difficulties can arise.

Psychological symptoms such as mood swings, insomnia and depression can make it difficult to enjoy sex.

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The good news is that all these problems can usually be remedied – chiefly through commonsense advice from a doctor (or from a therapist who is experienced in dealing with menopause problems), together with sympathy, understanding and love from the woman's partner. And some of them can be treated with hormones.

But in February 2015, the medical journal Sex And Relationship Therapy published an article by Canadian Health Educator Lyba Spring, who stated that hormones aren't the complete answer to sexual difficulties problems of post-menopausal women.

She said: 'There are issues to consider that both family doctors and therapists may overlook. More evidence is required to determine ways that older women may be helped to live a healthy sexual life.'

Certainly, hormone replacement therapy (HRT) isn't a miracle cure for all of the symptoms listed above. And contrary to what many people believe, it doesn't suddenly make you very aroused.

But oral HRT tablets should more or less abolish hot flushes (flashes) and night sweats, and make you generally feel better. And they will probably improve vaginal dryness, and therefore abolish pain during sex.

However, for vaginal soreness/discomfort, you really need the hormone in the form of a cream or ring which you can put into your vagina – as we'll discuss in a moment.

There may soon be some new treatments which will allegedly boost a woman's libido.

Medicine companies are working on them, but they still haven't arrived.

Hormone replacement therapy (HRT)

'HRT' means giving natural or synthetic female sex hormones that replace the hormones which the woman is not producing.

HRT comes in the form of tablets, patches or gels and always contains oestrogen (either in a natural or synthetic form), and often a progestogen as well. (A progestogen is similar in effect to the female hormone progesterone.)

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HRT is extremely good for relieving menopausal symptoms like hot flushes, night sweats and vaginal dryness. Unfortunately, since about 2003 it has becomer increasingly clear that it is not as free from ill-effects as we had been led to believe.

However, if used sensibly, it can be a great help to many women – particularly where sex is concerned.

What does 'used sensibly' mean? Basically, it means following the current official UK guidelines – which are to take the lowest possible dose for the shortest period of time.

Vaginal HRT. One particularly important use of a form of HRT is the application of hormone creams (or hormone-containing pessaries or rings) to the vagina to correct soreness and dryness.

While ordinary sex lubricants – like K-Y Jelly, Liquid Silk and Pjur Woman – can be very helpful for making intercourse comfortable and satisfying, sometimes the prescription of a female hormone preparation is necessary.

So if your vagina and vulva have become a little dry or sore, it may well be worth asking your GP, family planning doctor or gynaecologist about the following five oestrogen preparations which are currently available in the UK:

Please note that although these products are used for their 'local' (ie vaginal) effects, some of the hormone could be absorbed into your system. So there is a small possibility of side-effects elsewhere – notably in the womb.

Therefore, current advice is that these vaginal preparations shouldn't be used continuously long-term. If any unexplained symptoms occur (such as vaginal bleeding or abdominal pain) see a doctor for a check-up.

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Also, bear in mind that vaginal hormone preparation can sometimes be absorbed by the male partner during sex, through his penis -- with the result that he develops small breasts. So don't insert the cream or pessary just before you make love.

Note: My own (David Delvin) clinical experience is that these vaginal hormone products can also sometimes improve the urinary symptoms, which often occur round the menopause. However, they are not a treatment for urinary infections.

Testosterone and your sex drive

A number of gynaecologists (particularly those who are in private practice) believe that if a woman loses her sex drive at the menopause, this is due to low testosterone levels.

That may surprise you – since testosterone is of course the male sex hormone. But the ovaries do produce some testosterone. And these consultants claim that this hormone boosts women's libido. Therefore, they prescribe it – by tablet, injection or implant.

I must honestly say that most doctors don't seem to agree with this viewpoint. So you would find it difficult to get a testosterone 'passion booster' prescribed on the National Health.

In November 2014, a Michigan University study involving 3,300 American women concluded that testosterone only plays a minor role in post-menopausal women's sex lives.

Enjoy sex after the menopause

It is now known that women have much the same ability as men to enjoy sex. Indeed, many females are a good deal more highly-sexed than their partners!

Women also have the advantage of retaining their capacity to have several orgasms one after another until very late in life.

In contrast, young men are capable of frequent love-making, but as they get older they aren't able to do it so often.

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Ironically, some women discover a renewed or even redoubled libido after the menopause, and sometimes report that their husbands can no longer keep up with their sexual demands. In these cases, buying a sex aid – such as a vibrator – can be a good idea.

For many postmenopausal women, the fact that their partners take longer to reach a climax becomes a bonus; it makes love-making far more enjoyable than when they were younger and everything seemed to be over in a matter of breathless seconds.

This more prolonged love-making can provide time for both partners to explore new sensations and enjoy a variety of feelings.

Touching and intimacy

After the menopause, touching and intimacy can sometimes become more important than the physical pleasure of penetrative sex.

This need to touch and be touched, physically and emotionally, is well worth nurturing.

Such contact offers reassurance and comfort and the opportunity to show tenderness, companionship and love.

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